Your Alzheimer’s Questions Answered: Q&A with Rudy Tanzi

We collected your questions about Alzheimer's from our fall symposium and social media and presented them to Dr. Rudy Tanzi, chairman of our Research Consortium. Watch the videos below!

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Part 1: Alzheimer's and Genetics

Is Alzheimer's hereditary?Yes. All cases have some genetic component. The earlier the age of onset, the stronger the role of genetics. The later the age of onset, the more interplay of genes with environment and lifestyle.

If I have no family history, am I still vulnerable to Alzheimer's?Yes - especially if you live longer than your ancestors. You shouldn't assume you're immune just because you have no family history of Alzheimer's.

Can we recommend genetic testing for anyone?Only if it's reliable, and only for families with a history of early-onset Alzheimer's which often involves the especially virulent presenilin 1 and 2 genes. For late-onset Alzheimer's, we're still finding the relevant genes. Also, the direct-to-consumer testing out there is not reliable.

Even if the testing was reliable, we're not at the point yet where this information would allow us to give you a personalized medicine/treatment strategy. Still, some people will just want to know.

How accurate is the APOE score in prediction of Alzheimer's?Not very accurate. First, it depends how many copies of the gene you have. One copy of APOE4 increases your risk three- to four-fold. That doesn't at all mean that you're guaranteed to get the disease in your lifetime. Even if you have copies from both parents, you are not guaranteed to get the disease - and it could take until you're 90 to manifest.

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Part 2: Risk and Prevention

Do vegetarians get Alzheimer's at lower rates than meat-eaters?We don't know that. Most vegetarians still eat dairy products, so they're still getting animal fat in their diets. It'll be interesting to see whether vegans, who eat no animal products, get Alzheimer's. That study hasn't been done yet.

The only data about vegetarianism is with animals - old carnivores get Alzheimer's; old herbivores don't (so far).

Thoughts on turmeric?Turmeric lowers amyloid production and aggregation…in a petri dish. The problem with turmeric (or more specifically, the 'active ingredient' curcumin), is that it doesn't get into the brain very well, and therefore can't help much with Alzheimer's pathology. There are other good things about curcumin, though - some studies say it could have anti-cancer effects.

At Cure Alzheimer's Fund, we're developing some curcumin-like compound that can get into the brain. If these can be made safe, they may be effective against Alzheimer's.

What about coconut oil?I'd like to see a real trial. I'm intrigued by the anecdotes, but as a scientist, you get burned by anecdotes all the time. There are companies doing some trials now. Non-virgin coconut oil can have negative health effects - it raises your triglycerides.

What do you, Dr. Tanzi, do to lower your own risk of getting Alzheimer's?I stay intellectually and socially engaged. I'm a vegetarian - we don't know for sure, but I do think that will help. The only supplement I take is called ashwagandha, which has anti-amyloid effects. Unfortunately, most of the ashwagandha you'll find online does not work. The best one comes from Douglas Labs, but you need to get it through a doctor.

Is transcranial magnetic stimulation (TMS) being used to treat Alzheimer's?There are clinical trials going on, yes. We should keep an eye on it, based on the early data. It would be another way of stimulating the brain and getting synapses activated, similar to social and intellectual stimulation, and replenishing the neural network. TMS would be a largely symptomatic treatment - a way to boost cognition beyond drugs like Aricept. There's no reason to think it would stop the disease process.

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Part 3: Alzheimer's and the Body

How do we know exercise is so important in preventing Alzheimer's?There have been numerous epidemiological studies and trials to prove that exercise lowers risk for Alzheimer's. I think the real hardcore data came from Sam Sisodia. He showed that if you gave Alzheimer's mice running wheels and let them exercise, they had less amyloid in their brains.

Is sleep important in Alzheimer's prevention?David Holtzman showed that in deep sleep, amyloid production is turned off. Deep sleep also helps to consolidate short-term memories into long-term memories, and it's when the brain "cleans" itself. To get into deep sleep, you have to sleep for enough time - more than just four or five hours.

What's the connection between stroke and Alzheimer's?Strokes create damage in the brain, and can cause temporary problems with learning and memory as the brain heals. But what can also happen is that a stroke, like a physical head injury, can initiate amyloid and tau formation. Those may spread and therefore start the disease process. This doesn't always happen, but it can. Risk of stroke is one of the reasons why heart health is so important to brain health.

Is Alzheimer's a fatal disease?Yes, if you live long enough to get to the end stages. It can last 8-17 years. Many patients die because they are bedridden and their immune systems are compromised. The most common "cause of death" in Alzheimer's patients is actually pneumonia. This is one of the reasons we don't really know how many Alzheimer's cases there are - the death certificates for many will say "pneumonia".

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Part 4: Alzheimer's and Other Diseases

Could sleep apnea lead to Alzheimer's disease?Sometimes sleep apnea is an indicator of vascular problems. Vascular problems can lead to neurovascular problems, like stroke - which can trigger Alzheimer's. Sleep apnea is just not a good thing to have, for your heart or your brain.

Is there a connection between multiple sclerosis (MS) and Alzheimer's?Remarkably, there's really not much of a connection. MS also involves inflammation, but it's pretty distinct.

Is there a connection between Parkinson's and Alzheimer's?Parkinson's pathology affects the part of the brain involving movement. It can eventually spread to the parts of the brain involving learning and memory. So you can see Alzheimer's-like symptoms in later-stage Parkinson's patients. The same thing can happen with late-stage Alzheimer's patients exhibiting Parkinson's-like symptoms.

What's more interesting is that Alzheimer's, Parkinson's, Lou Gehrig's disease, and frontotemporal dementia - all these diseases have similar ways of killing nerve cells.

In trying to cure Alzheimer's, are we coming up with therapies that might be effective against other diseases?Yes. For example, all neurodegenerative diseases (Alzheimer's, Parkinson's, Lou Gehrig's, frontotemporal dementia) involve inflammation. A drug fighting inflammation would likely be effective towards all these diseases.